Provider Demographics
NPI:1730839762
Name:BOURDILLON, ALEXANDRA TAN (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:TAN
Last Name:BOURDILLON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22362 REGNART RD
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-4825
Mailing Address - Country:US
Mailing Address - Phone:408-516-7108
Mailing Address - Fax:
Practice Address - Street 1:2233 POST ST FL 3
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3470
Practice Address - Country:US
Practice Address - Phone:415-476-4952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty